You’ve recently been diagnosed with fibromyalgia, or maybe you’ve been living with it for a while. The pain is relentless. The exhaustion makes you feel like you’re half dead. And knowing this, your doctor still tells you “Get some exercise. You’ll feel better.”
You look at your doctor in stunned amazement. How could a person that educated be so stupid? Didn’t you just finish saying you’re wiped out by pain and fatigue? How are you supposed to exercise when you feel like this?
It turns out that both you and your doctor are right. Exercise does cause symptomatic improvement. But too much activity, the wrong type of activity or activity at the wrong time can trigger flares or make them worse.
As a health practitioner who has had fibromyalgia since childhood, I’ve lived both sides of this scenario so I’m going to share some insider tips on how to manage your activity levels before, after and during flares. Yes, it can be done.
Habits Are A Superpower
We talk about our habits dismissively. “Oh, that’s just a habit.”
In fact, habits are extremely powerful. Anyone who has tried to break a habit can attest to their power. When it comes to health, they are the key to success or failure. They can help you get through flares faster and reduce their number and frequency. Or they can keep you stuck in an endless state of impairment. When you choose the habit, you choose your state.
Habits result from the chronic repetition of a pattern of behaviour which was initially a choice. As the pattern becomes engrained, it becomes more automatic. You pay less attention to it. The automation of behaviour freeing your attention to turn to other things is what makes habits powerful. Deliberate cultivation of health-supporting habits is what takes them from powerful to super powerful.
Harness Your Habits Before You Flare
What I mean by “harness” is bring them under your control. Examine them consciously. If your favourite activities are sedentary, you need to be aware of that because you will have more inertia to overcome to be active. If your favourite activities include sports or other forms of physical exertion, you need to be self-aware about any tendencies to push too far or too hard.
Identify Your “Always Activities”
“Always Activities” are things which you enjoy that you could continue to do in a flared state. Examples might be stretching, walking, swimming, yoga or tai chi. If you are not doing these kinds of activities on a regular basis, pick one and begin to do it daily. If you are in a deeply flared state, start with stretches in bed. When you can walk to the bathroom without feeling exhausted, extend the distance you walk inside your home gradually. Start with two minutes and work up from there. Your goal is to make your Always Activities so habitual that you will miss them if you don’t do them.
Work Within Your Energy Envelope
“Energy envelope” is a term used in healthcare and medical research to describe the pool of energy a person can use to perform daily activities.
“Spoon Theory” is a way of explaining the idea of an energy envelope, developed by Christine Miserandino. She explains it in the video below.
Understanding the nature of your energy envelope is central to the practice of pacing. Pacing means you keep some spoons for later; you always do a little less than you think you could if you pushed yourself. Pushing, or over-doing, leads to flares.
When you work within your energy envelope, you notice when you begin to fatigue. This is your body’s signal that it needs to rest, and these signals should be respected. When you respect fatigue signals and work within your energy envelope, your activity tolerance improves.
Start Low, Go Slow
You’re in a flared state, and the idea of exercise seems impossible. What do you do? Stretch in bed several times each day and walk to the bathroom. Any kind of deliberate movement counts. Progress to chair exercises.
Your flare is subsiding and you can now walk for 2 minutes inside your home. What next? Try a 5 minute walk outside. Pause when you need to.
When you can walk comfortably for 5 minutes, extend the length of time you walk. When you can walk for 30 minutes, try to do the same distance in less time. This helps to build tolerance for increased intensity. This progressive extension of duration and intensity can be used for activities other than walking, but if you’re starting from zero, walking is the best exercise to begin.
Pacing Includes Stress Management
We have to pace ourselves psychologically as well as physically. People with fibromyalgia have a stress response that is stuck in overdrive. It exacerbates fatigue by interfering with sleep and mood. Additional stress can trigger flares or make them longer and/or deeper.
Moderate intensity exerises such as stretching, swimming, walking, tai chi or yoga are stress-relieving but if you are not able to do much yet, you can turn breathing into a stress management activity.
Slow, deep breathing triggers the body’s relaxation response. The key is to focus all of your attention on your breath. When you first start to do this, don’t worry about intrusive thoughts. As soon as you try to soothe your mind, it will kick up a fuss like a toddler having a tantrum. Just bring your attention back to your breathing, over and over, for as long as it takes to have at least 4 slow breaths. This terrific video from Happify explains how this works as a form of meditation. Give it a try!